Understanding ADHD and Learning Disability Part VI: How is ADHD treated?

This is the sixth in a series on understanding Attention Deficit/Hyperactivity Disorder (ADHD).

Treatment

ADHD is commonly treated with parent education, school-based interventions, and medications such as stimulants (e.g., methylphenidate) and newer, nonstimulant drugs such as atomoxetine. Adults benefit from the same medications as children and may find some behavioural therapies helpful. On the behavioral side, children can be taught strategies for staying focused on a task such as following a detailed schedule, or for organizing materials. Adult ADHD can be a family problem as well as an individual problem. Because the symptoms of the disorder often wreak havoc on every member of the family, not just the individual with adult ADHD, it’s important for the entire group to undergo family therapy, even if the ADHD parent is already getting individual counselling. It is best to begin family therapy as soon as it becomes clear that the symptoms of adult ADHD are interfering with normal family functioning and thus avoid crises and emergencies that may take months or years to resolve. Family therapy may include teaching family members new skills and coping strategies, and therapy in which family members support and encourage each other and learn to communicate more effectively.

Drug treatment of ADHD

Many children with ADHD may also need medication. The use of stimulants to treat ADHD was first described in 1937.Since the late 1960s, stimulants such as Ritalin® or Adderall® have been prescribed to treat children with ADHD.

2011-12 shortage in U.S. market

In 2011 and 2012, there was a shortage of Ritalin® and Adderall® in U.S. pharmacies. Some say the shortage was caused by the US Drug Enforcement Administration’s (DEA) annual limits on the manufacture of controlled substances. The DEA argues that drug manufacturers had caused the shortage by applying their quotas toward more lucrative kinds of amphetamine-based medications. The shortage was resolved by November 2012. Currently, between 4 and 6 million children in the United States take one of these medications, which reduce hyperactivity and impulsivity, help improve the ability to focus, and even improve physical coordination. In fact, medications are so effective in helping people with ADHD that a recent shortage wreaked havoc for many families

Drug action

Nonetheless, there is concern about giving children a drug that is potentially addictive. Methylphenidate, the active ingredients in Ritalin®, acts like a weak form of cocaine to increase dopamine and noradrenaline levels but tend to do it all over the brain sometimes resulting in unwanted side-effects such as nervousness, drowsiness, insomnia, suspicion and paranoia. Concerta®is a slow release of methylphenidate while Daytranta® delivers the drug via a skin patch, similar to those used for nicotine replacement therapy.Adderall® is a mixture of amphetamine salts which also increase dopamine and noradrenaline levels but has a higher potential for abuse than Ritalin®.

Controversy

In addition, there is a worry that ADHD may be over-diagnosed, leading to the diagnosis and treatment of high-energy children who have difficulty in the classroom, but are medically normal. For this reason the effectiveness of treatments should be re-evaluated in each person on a regular basis to determine if the current treatment continues to be optimal. There are some reports that daily intake of fish oil can be helpful.

Part 2: Understanding ADHD and Learning Disability

Part 3: Understanding ADHD and Learning Disability

Part 4: Understanding ADHD and Learning Disability

Part 5: Understanding ADHD and Learning Disability